At the 2015 annual meeting of the American Academy of Allergy Asthma and Immunology, held in Houston, thousands of allergists from around the globe gathered to present studies and help advance the field of allergy and immunology. Allergic Living was there to cover it. Here is your inside look at big breakthroughs and what’s on the horizon for treatments.

The LEAP Study

This was the big one. The LEAP study had the entire conference buzzing and since the results were revealed as the closing keynote speech for the AAAAI conference, it has become the talk of the allergy community. The LEAP study’s found that having at-risk infants consume peanuts can teach the immune system tolerance and prevent allergy in 70 to 80 percent of cases.

The Peanut Patch Treatment

The “peanut patch,” also known as Viaskin Peanut, applies small amounts of peanut protein to skin daily, which desensitizes peanut allergic patients to the allergen over time – a process known as epicutaneous immunotherapy. The new treatment was presented at the AAAAI conference and recognized as a notable “up-and-coming treatment” of food allergy.

Oral Immunotherapy for Infants

Younger participants may have more success from peanut oral immunotherapy (OIT), according to a new findings presented at the AAAAI annual meeting. This study, conducted at the University of North Carolina Chapel Hill, was also highlighted as an “up-and-coming treatment” for food allergy.

Data on Stock Epi in Schools

More than 900 episodes of anaphylaxis occurred across 5,700 U.S. schools in the last academic year, according to the nationwide survey released at the AAAAI annual meeting. That’s a rate of more than one severe reaction a year in every 10 schools.

More than 900 episodes of anaphylaxis occurred across 5,700 U.S. schools in the last academic year, according to a newly released nationwide survey. That’s a rate of more than one severe reaction a year in every 10 schools.

Findings from the EpiPen4Schools survey, revealed at the American Academy of Allergy, Asthma and Immunology (AAAAI) annual meeting in Houston, show that 852 individuals (mostly students but also staff) experienced anaphylaxis, with some individuals suffering multiple reactions during the school year. Seventy-five percent of them were treated with an epinephrine auto-injector and – in 49 percent of the cases – it was a school-supplied “stock” epinephrine auto-injector that was used. The survey was sponsored by Mylan Specialty, which markets the EpiPen.

Dr. Martha White, a Maryland allergist and an EpiPen4Schools study author, says these findings speak to the importance of school-owned or “stock” auto-injectors – which schools in most states now keep available for emergency use. The data support stock epinephrine as an important “safety net” for students having their first reactions, she notes.

The survey includes data from 5,683 public and private kindergarten, elementary, middle and high schools across America which participated in the EpiPen4Schools® stock auto-injector program, an initiative of Mylan Specialty, the marketer of the EpiPen. The results were gathered over the course of the 2013-2014 academic year.

The results were contained in four abstracts at the AAAAI annual meeting. Here are the key findings:

919 anaphylactic events were reported from the 5,683 schools surveyed.

11% (607) schools reported at least one anaphylactic episode.

757 (89%) of those having severe reactions were students; 22% of whom had no known allergies.

75% of severe reactions were treated with epinephrine, considered the first-line treatment for anaphylaxis.

25% of cases reported other treatment (usually antihistamines).

“Anaphylaxis is a serious and often unpredictable health problem in the U.S., particularly among children and adolescents,” said Roger Graham, president of Mylan Specialty. “There have been too many tragedies reinforcing that when anaphylaxis occurs, every minute matters, and immediate access to epinephrine and emergency medical care is crucial.”

The unpredictability of anaphylaxis applies to students with diagnosed allergies as well as those with no known allergies, adds White.

“There’s always a first time [for a reaction]; that could be at home, it can be in school, it can be in a restaurant, it can be on the soccer field where they got stung,” White told Allergic Living. “But the bottom line was that, at least in this survey, and there have been other studies that have given similar data, 22 percent of the students that had an anaphylactic event in school had no prior history of anaphylaxis. So they were undiagnosed and would not have had medication at home or at school.”

Dr. Ruchi Gupta, associate professor of pediatrics at Northwestern University Feinberg School of Medicine, conducted an earlier, 2012-13 study of stock epinephrine use in Chicago schools, finding that 38 schools in that city used the school-supplied devices in one year.

Commenting on the need for stock epinephrine, she said at the time: “Because of the amount of time kids spend in school, and given the fact that many first-time allergic reactions occur on school grounds, it is imperative for school districts across the country to provide access to emergency epinephrine to students who may not otherwise have access to the potentially life-saving medication.”

In November 2013, President Barack Obama signed the School Access to Emergency Epinephrine Act, which provides financial incentives for states to adopt laws allowing schools to stock auto-injectors. Most states now allow schools to stock epinephrine, and emergency auto-injectors are required in California, Nevada, Michigan, North Carolina, Nebraska, Virginia, Maryland, and Delaware schools.

New Hampshire, Hawaii, and Iowa are the only states that currently have no epinephrine laws or regulations in place.

While the data presented at AAAAI demonstrates the use of stock epinephrine auto-injectors in schools, White emphasizes it does not replace the need for students with known allergies to have their own epinephrine auto-injectors.

Adults and children who experience anaphylaxis do not always receive live-saving epinephrine, according to findings from a three-year Canadian study.

“In adults, our study indicates that almost 50 percent of severe reactions are not treated with epinephrine in or outside of the hospital,” says Dr. Moshe Ben-Shoshan, a pediatric allergist at Montreal Children’s Hospital and a key researcher behind the Cross-Canada Anaphylaxis Registry.

Started in 2011, the registry, known as C-CARE, has collected data from approximately 1,500 allergic adults and children who visited emergency departments in British Columbia, Ontario and Quebec hospitals. The goal was to gain insights into the triggers and management of anaphylaxis.

In a related research paper from the C-CARE data, the rates of epinephrine use in children having reactions proved to be better than the adult patients, but could still stand improvement. Data collected from the Montreal Children’s Hospital emergency department showed that the most common triggers for reactions were peanut and tree nuts, and that nearly 1 in 3 children experiencing reactions did not receive epinephrine. Almost all of these children had been prescribed auto-injectors.

The children not receiving epinephrine were given either antihistamines or corticosteroids to bring a reaction under control. “Antihistamines and steroids are not established as primary management of anaphylaxis and further,” Ben-Shoshan said in an interview. “The only drugs that stops the progression of anaphylaxis is epinephrine.”

Antihistamines and steroids may treat visible symptoms such as hives, they do not tackle the systemic symptoms such as cardiac or breathing issues. Therefore, the allergist says, not using epinephrine right away can actually make a person’s condition worse.

Ben-Shoshan cites the case of one allergic teenager who ate a cookie she was handed as a store sample. She quickly realized the cookies contained peanut butter, and her mouth began to itch. She did not have her epinephrine auto-injector with her, so a friend drove her to the emergency department. When she arrived, she was walking, talking and had only minor symptoms. Within a few minutes, she collapsed. She received CPR and an epinephrine drip to stabilize her condition, and was admitted to intensive care where she later recovered.

“Had she injected [epinephrine] promptly, all the studies indicate that she is not likely to have deteriorated the way she did,” says Ben-Shoshan. The C-CARE data found that the prompt use of epinephrine may also prevent the need for additional doses of the drug in the emergency department.

The low rate of epinephrine use among adults experiencing anaphylaxis is a growing concern. Ben-Shoshan suggests the trend likely relates to concern about side effects, a common misconception. (In fact, the C-CARE data reveals that most of the adults who used the drug experienced no side effects.) The researcher says that it’s also not uncommon for patients to make a “distorted link” between giving epinephrine and having to go to the hospital, believing that if they don’t administer epinephrine, the reaction is less severe and they can stay home.

“On the contrary, if you don’t give epinephrine, you’re more likely to deteriorate and end up at the hospital,” he says. The registry data also show that nearly half of the adult patients with moderate-to-severe reactions did not own a prescribed auto-injector.

C-CARE, funded in part by AllerGen, is the world’s first registry to track anaphylaxis occurrences as they are reported, and the researchers plan to publish the four-year findings in 2015.

The medical guidelines state that any serious allergic reaction requires epinephrine. “It’s clearly indicated. It’s the educational programs that need to be distributed and implemented,” says Ben-Shoshan.

]]>http://allergicliving.com/2015/01/22/canadians-hesitant-to-use-epinephrine-study-finds/feed/0Disney to Place ‘Stock’ Auto-Injectors at Its Parks and on Cruiseshttp://allergicliving.com/2014/11/12/a-whole-new-allergy-safe-world-disney-to-stock-epipens-at-its-parks/
http://allergicliving.com/2014/11/12/a-whole-new-allergy-safe-world-disney-to-stock-epipens-at-its-parks/#commentsWed, 12 Nov 2014 14:00:53 +0000http://allergicliving.com/?p=30752“The most magical place on Earth” has just made a monumental advance in accommodations for those with food allergies. Walt Disney Parks and Resorts and Disney Cruise Lines has inked a deal with Mylan Inc., the distributor of the EpiPen, to make stock epinephrine auto-injectors available at (or aboard) its key U.S. properties, including California’s Disneyland and Florida’s famous Disney World.

“We are very proud to be working with Disney, which already has a strong reputation for meeting the needs of people managing severe allergies, and believe we can further raise awareness of anaphylaxis through this collaboration and our joint commitment to education,” Mylan CEO Heather Bresch said in a media release.

This is the first major placement of “stock epinephrine” outside of schools. Such auto-injectors are not prescribed to an individual, but are kept available in case of anyone’s severe allergic reaction. (Individuals are still meant to carry their own auto-injectors.)

Walt Disney Studios map - Click to enlarge

EpiPen and EpiPen Jr auto-injectors will be placed at multiple locations at Disney resorts, parks and on cruise ships. Disney guide maps will now include an EpiPen symbol, identifying auto-injector locations – similar to what is currently done for automated external defibrillators. Signage in the parks and on cruise ships will also be updated to help direct guests to the life-saving medicine.

“For our guests who live with severe allergies every day, identifying EpiPen locations is an additional tool they’ll have for their anaphylaxis management plan,” said Dr. Pamela Hymel, chief medical officer for Walt Disney Parks and Resorts.

Mylan and Disney also plan to work toward introducing educational materials, which will discuss signs, symptoms and how to be prepared for a life-threatening anaphylactic reaction.

The EpiPen announcement follows Florida’s new legislature that allows public venues – such as restaurants, sports arenas and theme parks – to carry and store epinephrine auto-injectors for emergency use by the public. The Emergency Allergy Treatment Act (HB 1131), which was signed into law in June, ensures that epinephrine is readily accessible if anaphylaxis occurs – a particularly important step for those with unknown allergies.

“People who know they are allergic to various types of stings, they’re usually good about having an auto-injector,” Rep. Matt Hudson, who introduced the bill, told Allergic Living. “But in the case of food allergies, sometimes you just flat out don’t know.”

EpiPen auto-injectors are scheduled to appear at the Disney locations and on the cruise line later this year. It’s an important safety measure since, as Bresch points out, “Like life, severe allergic reactions are unpredictable, so people need to be prepared.”

]]>http://allergicliving.com/2014/11/12/a-whole-new-allergy-safe-world-disney-to-stock-epipens-at-its-parks/feed/0Valentine’s Day Pop Quizhttp://allergicliving.com/2014/02/11/valentines-day-pop-quiz/
http://allergicliving.com/2014/02/11/valentines-day-pop-quiz/#commentsTue, 11 Feb 2014 20:29:03 +0000http://allergicliving.com/?p=24112When the marketers and distributors of the EpiPen auto-injector did some research on the trends for Valentine’s Day, they found some statistics that might surprise you.

Pop Quiz! See if you can guess whether the following statements are myth or fact.

]]>http://allergicliving.com/2014/02/11/valentines-day-pop-quiz/feed/0Awareness Campaign to Award $60K to U.S. Schoolshttp://allergicliving.com/2013/05/24/awareness-campaign-to-award-60k-to-u-s-schools/
http://allergicliving.com/2013/05/24/awareness-campaign-to-award-60k-to-u-s-schools/#commentsFri, 24 May 2013 19:09:01 +0000http://allergicliving.com/?p=17598A new anaphylaxis awareness campaign will award a total of $60,000 in grants to four U.S. public school districts. The four districts which get the most votes (or ‘hands raised’) online will each be awarded a grant of $15,000 to support educational programs.

“Raise Your Hand for Anaphylaxis Awareness,” sponsored by Mylan Specialty (the U.S. distributor of the EpiPen), is an offshoot of the company’s “Get Schooled in Anaphylaxis” initiative, with TV star and allergy mom Julie Bowen acting as a celebrity spokesperson. Earlier this year, ALinterviewed Bowen, who has a son with life-threatening allergies to bee stings, nuts and peanuts, and spoke with her about what it was like to find herself in the role of allergy mom.

“It’s been a real eye-opener to realize how many parents, like me, didn’t know their child had life-threatening allergies until anaphylaxis occurred,” said Bowen in a recent press release.

In order to cast a vote for a district, anyone can vist Anaphylaxis101.com, register, sign in and select their district. Votes can be cast once per day, and there will be special days announced where a single vote is worth extra.

“Anaphylaxis can occur quickly, making fast action and response critical. The Raise Your Hand for Anaphylaxis Awareness competitionis an easy way to help promote anaphylaxis education in school communities across the country so people are prepared to respond,” said Dr. Hemant Sharma, a contributor to Allergic Living, in a press release.

The competition will be open until October 1, 2013 for individuals aged 13 and older. To vote for your district, and for complete competition rules, visit anaphylaxis101.com.

According to local news reports, Tanner Henstra, who also had asthma, was at a friend’s house last week when he took a pretzel from a bowl and popped it in his mouth, not realizing these pretzels were filled with peanut-butter. His mother, Stacie Henstra, told The Salt Lake Tribune that her son spat out the pretzel as soon as he tasted peanut, but the allergic reaction had begun. His tongue and throat began to swell.

Stacie Henstra said Tanner usually carried an epinephrine auto-injector with him, but he did not have the emergency device with him at his friend’s house. She also said that the boy, who had been diagnosed allergic as an infant, had never needed to use one before.

Tanner did have some other allergy or asthma medicine with him, which he took immediately before calling his mother, who is a nurse, to come pick him up.

“He sounded worried but otherwise OK,” Stacie Henstra told the Tribune. But during the drive home, Tanner began to have trouble breathing. When they got home, about four minutes away, a neighbor came outside and performed CPR on Tanner while his mom ran inside to get the EpiPen.

She gave him the injection, but it had little effect. He was transported to a local hospital in St. George (which is north of Las Vegas), then to a larger hospital in Salt Lake City. After two days in hospital, Tanner was removed from life support.

Allergic Living reminds readers of the need for constant vigilance with food allergies. Most important of all, we remind you that anaphylaxis can progress swiftly and that the drug epinephrine is most effective when used immediately. Please take a moment to review our emergency procedures slideshow – Six That Save Lives.

A comprehensive new training course for understanding and managing anaphylactic emergencies has just launched online.

“First Aid For Anaphylaxis: An Allergic Emergency” fills an important educational gap by providing clear instructions for what steps to take if witnessing an anaphylactic reaction. It provides easy-to-follow, standardized information in line with World Allergy Organization (WAO) guidelines.

“We have created this course to protect allergic individuals by ensuring that the first on the scene are trained to recognize an allergic emergency – anaphylaxis – and respond immediately with life-saving first aid,” said Dr. Mark Greenwald, the Toronto allergist who co-created the course with Elizabeth Goldenberg, a lawyer and allergy advocate.

“This medical emergency requires immediate first aid – the individual can’t wait for emergency crews to arrive,” said Greenwald, referring to the need for quick response with emergency epinephrine when an anaphylactic reaction is in progress.

Greenwald and Goldenberg founded EpiCenter Medical Inc., the company that offers this online course, which provides excellent guidance for parents of allergic children, their caregivers and school and daycare staff. But the course is also designed to be used more widely in the community: staff in restaurants, dental offices, airlines, government offices, hotels, and sports venues are among those Greenwald sees benefiting from its emergency training.

“When staff in those locations are called to respond to a reaction on their premises, they will know how to recognize anaphylaxis, to treat anaphylaxis immediately with epinephrine for the best survival rate, and what life-saving steps to take next,” he says.

Anyone with Internet access can take the course, which is divided into modules:

• It begins with definitions of allergy and anaphylaxis, and moves into an explanation of epinephrine and easy instructions on how to use an epinephrine auto-injector. (So far, the course gives details on the widely prescribed EpiPen, but this may be updated soon to include the new Auvi-Q/Allerject injector.)
• As the lessons progress, participants learn how to spot anaphylaxis, and are given clear steps to follow (and remove any lingering doubt) during an anaphylactic emergency.
• As legal questions can arise among would-be good Samaritans, legal consequences are also covered, from injecting the life-saving shot into someone else, to the ramifications of deciding not to do so.

To confirm the participant’s comprehension (and keep the user engaged), quizzes are taken throughout to test knowledge. Users cannot move on to the next section until they have passed the previous one.

Allergic Living was glad to see that EpiCenter Medical’s course stresses that it’s always better to give the shot, and immediately, in the case of a suspected anaphylactic reaction. Delay can reduce the chance of epinephrine being effective, and there are no harmful effects associated with giving the shot to a healthy person who doesn’t require it.

Those who complete the online course are able to print out a personal certificate stating that they are S.A.V.E. certified – which stands for Save Anaphylaxis Victims in an Emergency.

EpiCenter Medical also offers sale of an ‘Epi-Kit’, which is a case of multiple EpiPens designed to be placed in public locations, in a manner similar to automated external defibrillators. The idea is that an Epi-Kit should always be available within 60 seconds of an anaphylactic emergency.

In summary: This course provides highly valuable information and life-saving instructions. It is excellent as a standalone course, and could also be integrated into CPR courses, so that any first responder in an anaphylactic emergency will know what steps to take to save a life.

The course is available at epipentraining.comCost for an individual: $29.95 – Update: as of Jan. 21, 2014, now being offered for FREE to individuals.
Discounted group rates available for groups larger than 10

Allergic Living’s Gwen Smith: Julie, how did you first become aware of your child’s food allergies?

Julie Bowen: I was at work on Boston Legal and my husband was at home. He sent me a text saying, ‘I think we have a problem with our son and peanut butter.’ I said, ‘but he’s had it before,’ and then he said – ‘and he got stung by a bee’. And I was thinking, ‘What is going on over there?’

AL: You mean he was stung at the very same time he was reacting to peanut butter?

JB: Well, it is California and our doors are open all the time. So he [her son Oliver] had wandered out eating peanut butter and was stung by a bee. I was one to think this was no big deal until my husband sent me a picture of our son’s face, which was clearly in distress. It was swollen and disfigured.

My husband rushed him off to the emergency room and he was treated with epinephrine, and after that we learned that Oliver had allergies to all sorts of nuts and peanuts and probably also to stinging insects – but that’s a different series of tests.

After the anaphylactic reaction, I know that my job is to be aware and to be prepared for the next reaction – whenever that may be.

AL: These days you’re a big TV star, you’ve won a second Emmy and the show is a huge hit. But facing anaphylaxis, is that the great leveler?

JB: You know, I think being a parent is the great leveler. People often ask me how my life has changed since Modern Family. And I say, ‘Having three kids in three years was a much bigger change than having a lovely, lovely job.’

AL: What ages are your kids?

JB: Oliver is the older boy and we have twin 3-year-old boys. [So far, no life-threatening allergies have been diagnosed with the twins.]

Next: Bowen’s decision to get involved in the “Get Schooled in Anaphylaxis” campaign.

]]>http://allergicliving.com/2013/04/16/profile-actress-julie-bowens-role-as-allergy-mom/feed/0How Does Epinephrine Turn Off an Allergic Reaction?http://allergicliving.com/2013/04/10/how-does-epinephrine-turn-off-an-allergic-reaction/
http://allergicliving.com/2013/04/10/how-does-epinephrine-turn-off-an-allergic-reaction/#commentsThu, 11 Apr 2013 01:13:52 +0000http://allergicliving.com/?p=16852Q. How does epinephrine turn off an anaphylactic reaction? This seems rather amazing, since anaphylaxis affects so many body systems.

Dr. Sharma: The ability of epinephrine to treat the many signs of anaphylaxis is rather amazing.

It acts on a number of receptors in the body to exert its effects. First, it causes constriction, or tightening, of the blood vessels, which decreases swelling and also helps to increase blood pressure.

It also increases the heart’s contraction and heart rate, which can help to prevent or reverse cardiovascular collapse. Epinephrine relaxes the muscles around the airways in the lungs, helping the airways to open up.

Finally, it prevents the release of additional allergic chemicals, which aids in stopping further progression of the reaction. No other medicine acts on so many body systems, which is why epinephrine is the drug of choice for anaphylaxis.

Dr. Sharma is an allergist, clinical researcher and Assistant Professor of Pediatrics. He is Associate Chief of the Division of Allergy and Immunology at Children’s National Medical Center in Washington D.C. and Director of the Food Allergy Program. He co-authors “The Food Allergy Experts” column in the American Edition of Allergic Living magazine. Questions submitted below will be considered for answer in the magazine.